Provider Demographics
NPI:1407189517
Name:WINDOW TO THE BODY
Entity Type:Organization
Organization Name:WINDOW TO THE BODY
Other - Org Name:THE DETNAL RANCH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MATT
Authorized Official - Middle Name:FREDERICK
Authorized Official - Last Name:KERN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-336-8839
Mailing Address - Street 1:850 W HWY 243
Mailing Address - Street 2:
Mailing Address - City:KAUFMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75142
Mailing Address - Country:US
Mailing Address - Phone:888-336-8839
Mailing Address - Fax:972-438-2540
Practice Address - Street 1:850 W HWY 243
Practice Address - Street 2:
Practice Address - City:KAUFMAN
Practice Address - State:TX
Practice Address - Zip Code:75142
Practice Address - Country:US
Practice Address - Phone:888-336-8839
Practice Address - Fax:972-438-2540
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WINDOW TO THE BODY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-09-09
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty